Method and system for extracting medical information for presentation to medical providers on mobile terminals

ABSTRACT

A system for providing medical providers with medical records accessible from a mobile terminal in one embodiment comprises reformatting the information in a medical record database to be used with large, ergonomic icons allowing easy transitions between pages of information in the medical record. Docking stations or wireless networks may enable the mobile terminal to access the medical records. Thus, the medical provider may have bedside access to the information in the medical records to make informed decisions about treatment regimens.

BACKGROUND OF THE INVENTION Cross-Reference to Related Applications

This application claims priority to U.S. Pat. No. 7,831,449 filed Feb.2, 2001 entitled “Method and System For Extracting Medical InformationFor Presentation To Medical Providers On Mobile Terminals,” the contentsof which are incorporated herein by reference in their entirety.

Copyright Notice

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by anyone of the patent documentor the patent disclosure, as it appears in the Patent and TrademarkOffice patent file or records, but otherwise reserves all copyrightrights whatsoever.

Field of the Invention

The present invention relates to a technique for accessing medicaldatabases and delivering the content thereof to medical providersthrough a mobile terminal.

DESCRIPTION OF THE RELATED ART

Medical providers are notoriously resistant to change in theirworkplace. As a result, they frequently do not accept new technologysimply because it is new and may not be better. Medical providers oftenonly accept change when they have to or when it truly does make theirjob demonstrably easier and/or faster.

Conversely, a common complaint among many medical providers is the lackof access to information needed to treat patients effectively. Medicalproviders are loath to travel to an inconveniently located desktopterminal or workstation only to spend several minutes logging into thesystem, accessing a database, and then slowly sifting through themedical records that may be contained therein in an attempt to find abit of desired information and then transcribing it or printing it outfor later use.

Medical institutions, such as hospitals, may have a paper file with hardcopies of the pertinent medical information, but again, this iscumbersome, antiquated, and not always orderly. As more hospitals moveto electronic databases, even these portable, albeit outmoded, recordsmay be hard to come by. Thus, the two primary vehicles by which medicalrecords may be accessed are inadequate to help medical providers accessthe medical records where they are needed the most—by the patients'bedsides.

Let it not be said that medical providers are completely hateful of newtechnology. Many medical providers have become addicted to handhelddevices such as the ubiquitous PALM PILOT series of devices. Likewise,many doctors may supplement their PALMS or replace them entirely withwireless telephones and/or pagers. Such devices, collectively referredto as mobile terminals, are uniquely positioned to provide access to themedical records that the medical providers desire. However, a barrierremains in that the medical records are typically held in a proprietarydatabase isolated from wireless access and are not in a format that isconducive to presentation on a mobile terminal.

SUMMARY OF THE INVENTION

The present invention comprises a technique to enhance patient care byproviding medical providers with accurate, up to date, easily accessibleinformation about the patients in their care presented in an ergonomicand intuitive fashion. Initially, databases of medical records,typically stored by a hospital, are accessed and the informationcontained therein is extracted and reformatted in a consistent manner.Software may be used to perform this extraction and reformatting. Thesemedical records are then provided to the medical providers through amobile terminal.

In one embodiment, the present invention provides the medical records toa personal digital assistant such as a PALM PILOT. The display of thepersonal digital assistant comprises a plurality of large, ergonomicbuttons that may be used to transition between different screens ofinformation in the medical records. Medical providers synchronize to thedatabase at regular intervals to keep the records on the personaldigital assistant current as well as to update the hospital databasewith information entered into the personal digital assistant.

In a second embodiment, the present invention provides the medicalrecords to a mobile phone device. The mobile phone may have buttonsapart from the display by which the medical provider can againtransition through different screens of information in the medicalrecords. In this embodiment, the medical provider may download onlythose records that he needs as he needs them. Likewise, updates aretransmitted from the mobile phone back to the database. It should beappreciated that the hospital may have a Localized Wireless TelephoneSystem or comparable system serving the hospital campus through whichthe mobile phone communicates with the database.

Another aspect of the present invention is the promotion and salesassociated with this service. In particular, the present invention iswell adapted to provide a residual revenue stream for a service providerwho implements the service at a number of locations. Thus, the serviceprovider may initially contact hospitals and other sources of thetypically proprietary databases and secure permission to access andreformat the database for use with the other aspects of the presentinvention. This may involve a fee being paid by the service provider tothe database proprietor, or better, a fee paid by the proprietor to theservice provider. The service provider may further give away a number ofmobile terminals to select medical providers so as to generate interestin the service. A monthly service fee may be charged to the medicalproviders, much like mobile phone users pay a monthly service fee fortelephone service. Further mobile terminals may be sold by the serviceprovider or a third party as needed. Likewise, it may be possible forthe service provider to partner with a mobile network provider such asEricsson to help install Localized Wireless Telephone Systems inhospitals and the like so that the present invention may be practicedmore easily in hospital environments.

Still other aspects of the present invention involve charge captureservices, hospital census services, and the like, all of which may beintegrated into the same interface provided to the medical providers.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a flow chart describing accessing databases forcreation of the modified medical records of the present invention;

FIG. 2 illustrates a front plan view of a personal digital assistantwith a medical record displayed thereon;

FIG. 3 illustrates a schematic diagram of a hospital with multipledocking stations for synchronization of the personal digital assistantsof the present invention;

FIG. 4 illustrates another plan view of a mobile phone with a medicalrecord displayed thereon;

FIG. 5 illustrates a Localized Wireless Telephone System for use withthe mobile phones of the present invention;

FIG. 6 illustrates a schematic overview of the database organizationsuch as may be used in one embodiment of the present invention;

FIG. 7 illustrates an exemplary schematic chart of possible button linksused with the medical records of the present invention;

FIG. 8 illustrates a flow chart of the steps by which the presentinvention may be promoted to medical providers;

FIG. 9 illustrates a flow chart of an exemplary use session of themedical records of the present invention by a medical provider using apersonal digital assistant; and

FIG. 10 illustrates a flow chart of an exemplary use session of themedical records of the present invention by a medical provider using aphone device.

DETAILED DESCRIPTION OF THE INVENTION

The present invention comprises providing medical providers with medicalrecords in a mobile terminal so that the medical providers may accessthe medical records without being tied to a desktop workstation. Anindividual or a company, both herein referred to as a service provider,may be the moving force behind these activities. It is expected that theservice provider will be a profit oriented business who also desires tosee the quality of care to patients improve by the provision of themedical records to the medical providers.

Initially, the service provider will have to acquire the medical recordsin a format that is amendable to presentation on the mobile terminals. Aflow chart of this initial process is illustrated in FIG. 1. The serviceprovider, or a representative of the service provider, may contact themanagers of the databases containing the medical records (block 10). Itis expected that these managers may be hospitals or companies to whomhospitals have outsourced the medical record maintenanceresponsibilities. E.g., Cerner and Shared Medical System. In some cases,these companies merely sell software to the hospitals depending on thepreference of the hospital, in which case, the manager of the databasemay be a hospital employee. Additionally, it is possible that medicalproviders who are not associated with a hospital (e.g., a practicegroup, a partnership, a solo practitioner, or the like) may have medicalrecords amenable to incorporation and use in the present invention.Thus, the service provider may also contact such individuals or groupsand the present invention is not restricted to hospitals per se.

After the appropriate sales presentation, the database manager may pay afee to the service provider. Alternatively, the service provider may paya fee to the database manager. Regardless of the nature of thetransaction, the service provider secures access to the database (block12).

In one embodiment, the files are copied to a computer memory local tothe service provider (block 14), leaving the original databaseunmodified. The medical records are analyzed for the structure thereof(block 16). Specifically, it is desired to learn what fields of thedatabase contain what information. The service provider may then write asoftware program that extracts the information from the copied files(block 18) and inserts it into a new database in the format desired(block 20). The new database is then saved (block 22). This is a ratherbrute force approach, but is certainly possible.

In another embodiment, where the medical records only exist in a paperformat, the service provider may hire data entry personnel to read themedical records and enter the desired information into the new database.This is, as would be expected, inefficient and very labor intensive, buthaving been done once for that particular collection of medical recordsmay not need to be done ever again. For example, it may be appropriatewhen a wholesale conversion from a paper office to an electronic officeis contemplated.

In yet another embodiment, the original database may communicate withthe new database through standard Open DataBase Connectivity (ODBC)drivers. The service provider may then simply query the originaldatabase and derive the desired information.

In still another embodiment, the original database may be HL7 certified.HL7 stands for Health Level 7 and is a standard presently in its thirdversion. Details may be found at www.hl7.org. In essence, this standardallows data to be passed between providers and used as desired. Eitherof the last two cases greatly simplifies the extraction and translationof the data from the original database to the new database created bythe service provider.

The purpose of the extraction and reformatting is to present the data ofthe medical records in a format that is acceptable for display on amobile terminal. To facilitate an explanation of the methodology of thepresent invention, what follows is a discussion of the hardware. Itshould be appreciated that the term mobile terminal may include acellular radiotelephone with or without a multi-line display; a PersonalCommunications System (PCS) terminal that may combine a cellularradiotelephone with data processing, facsimile and data communicationscapabilities; a PDA that can include a radiotelephone, pager,Internet/intranet access, Web browser, organizer, and/or calendar; and aconventional laptop and/or palmtop receiver or other appliance thatincludes a radiotelephone transceiver. Mobile terminals may also bereferred to as “pervasive computing” devices. However, the presentapplication will focus on two such devices, namely personal digitalassistants (mobile terminal 50) such as that illustrated in FIG. 2 andmobile phones (mobile terminal 100) such as that illustrated in FIG. 4.Mobile terminal 50 may be a PALM PILOT@ or the like and may comprise adisplay 52 and a plurality of buttons 54 as is conventional. Display 52may include a data field 56 comprising a patient's name field 58, amovement icon 60 and a plurality of special icons 62. As is conventionalon most personal digital assistants, display 52 may comprise some formof touch screen, accepting inputs by touching the display 52. Display 52may further comprise a data entry field 64 used in conjunction with astylus (not shown) as is conventional. In one embodiment, the display 52comprises a color display with the icons and information displayedthereon colored to provide easy reading for the viewer. Movement icon 60may change the information and icons displayed, in effect acting like ascroll bar. Movement icon 60 and special icons 62 are sized so as to beactuatable by a finger rather than a stylus and include imagery that isa convenient shorthand representing medical information. Special icons62 are explained in greater detail below with reference to FIG. 6.

Personal digital assistants, such as mobile terminal 50 may not beequipped with long range transceivers and may require docking stationsthrough which they receive access to the database in which the properlyformatted medical records are contained. This situation is illustratedschematically in FIG. 3. In particular, a central server 70 may bepositioned anywhere within the hospital 72. Central server 70 maycomprise a single processor, a plurality of CPUs, or the like as neededor desired and have memory associated therewith on which the reformatteddatabase is stored. In one embodiment, the central server 70 may be anORACLE based server. Other servers may also be appropriate and theparticular server is not material to the present invention.

Hospital 72 may include a plurality of wards or divisions 74 each with adocking station 76 communicatively connected to the central server 70.In one embodiment, the connection is provided by EXTENDED SYSTEMS'XTNDCONNECT SERVER. In practice, medical providers will periodicallybring the mobile terminal 50 to one of the docking stations 76 andsynchronize with the information stored on the central server 70.Docking stations 76 may require a physical connection, but are morefavorably infrared transmission based, allowing synchronization of fiveto eight mobile terminals 50 simultaneously. An acceptable device to dothis the CLARINET SYSTEMS EthIR LAN that transforms standard existingEthernet connections to wireless access points. The EthIR Beam modulesupports Windows CE, PALM, EPOC, and LINUX devices, and is capable of 4Mbps throughput while complying with all the appropriate IEEE, FCC andIrDA standards.

It should be appreciated that the synchronization is designed to betwo-way. For example, in the morning, a medical provider docks hismobile terminal 50 in a docking station 76 and downloads informationinto the memory of the mobile terminal 50 related to his accessprivileges. As the medical provider performs his rounds, he or sheenters data into the mobile terminal 50 relating to treatment regimensand the like. Upon completion of the rounds, the medical provider docksagain, uploading the information entered into the mobile terminal 50into the database for sharing with other medical providers. Note thatthis upload may update the information not only in the central server70, but also in the original hospital database if it is stored in adifferent memory device, such as the original hospital server. Thisprocess of downloading and uploading, or synchronizing is wellunderstood in the art.

Note that hospital 72 is used as an example, and is not intended to belimiting. Smaller facilities may not need more than one docking station74 per building. Variations on this are well within the skill of thosein the art.

An alternate embodiment may incorporate radio frequency (RF) wirelesstechnology wireless protocols. An exemplary mobile terminal 100 isillustrated in FIG. 4, Mobile terminal 100 may comprise a keypad 102having numerical keys 104, directional keys 106 and a select key 108; adisplay 110; and an antenna 112 as is well understood in the wirelesscommunication industry. Mobile terminal 100 may be manufactured by anyone of a number of different manufacturers such as ERICSSON, NOKIA,MOTOROLA, or the like. Mobile terminal 100 may conform to such standardsas TWEIA-136, IS-95, CDMA, AMPS, D-AMPS, BLUETOOTH or the like. Thestandards are well documented and a further discussion is omitted. Notefurther, the mobile terminal 100 may also be a wireless enabled personaldigital assistant that is Bluetooth enabled, uses 802.11 standards orthe like. These sorts of devices avoid the need for synchronization.

Display 110 may comprise an information section 114 and an icon section116. Information section 114 may display information from the medicalrecord in a format that is easy to read, adapted for the size of thedisplay 110, and corresponding to one of the icons 118 in icon section116. Directional keys 106 and select key 108 may be used to highlightand select different icons 118 to move between different pages ofinformation being displayed in information section 114. In effect, theicons 1 18 become a menu and the keys 106,108 allow the menu to bebrowsed and a desired element of the menu selected.

Mobile terminal 100 may be equipped with a transceiver enabling two-waycommunication such as is well understood in the art and as explained inthe above mentioned standards. To that end, it is expected that thehospital 72 will have some sort of local, private wireless system inplace to facilitate communication between a central server 152 hostingthe reformatted database and the mobile terminals 100 in the possessionof the medical providers. One such local wireless system is illustratedin FIG. 5. Hospital 72 may be equipped with a Control Radio Interface(CRI) 150 that is communicatively coupled to a server 152 that housesthe reformatted database of the present invention, a plurality of radioheads 154, and an Mobile Switching Center (MSC) 160 within the PublicLand Mobile Network (PLMN) 162. The PLMN 162 may comprise a plurality ofbase stations 164 as is well understood and be connected to the PublicSwitched Telephone Network (PSTN) 166. Suitable local wireless systemsinclude the MOBILE ADVANTAGE™ Wireless Office sold by Ericsson, or theRBS 884 PICO SYSTEM, also sold by Ericsson. Other networks are alsopossible. Mobile terminals 100 may move around within the local systemjust like they move about in a normal cellular system. Note further thatthe local wireless system need not be connected to the PLMN 162 if sodesired. For example, for security reasons, it may be desirable not toallow access to the PLMN 162 and the PSTN 166.

In addition to making normal phone calls, receiving pages, short messageservices and the like, the mobile terminals 100 may also selectivelyaccess the server 152 and secure therefrom a medical record formattedaccording to the present invention. It should be appreciated thatappropriate encryption technology may be used so as to preserve theprivacy of the medical information. The medical record is then displayedon the display 110 of the mobile terminal 100. In particular, mobileterminal 100 communicates via antenna 112 to a nearby radio head 154 andaccesses server 152 through the CRI 150. The server 152 obliginglyprovides the requested information, which in turn is transmitted fromthe radio head 154 to the mobile terminal 100 for display. Any updatesentered by the medical provider are forwarded upon entry by the medicalprovider to the server 152.

Note that servers 70, 152 may communicate with the computer containingthe original, unaltered database of medical records, providing updatesthereto as needed or desired. Thus, these computers may be networkedthrough a conventional approach, selectively connected over a modem orthe like as needed or desired.

As another embodiment, one in which the hospital database is used moredirectly, the hospital database is connected to a translator server suchas an HL7 parser which in turn puts the information from the hospitaldatabase into a staging database, perhaps on the same sewer. The dockingstations 76 or radio heads 154 then communicate with the stagingdatabase as previously described. This embodiment allows the medicalproviders to have access to the information in the hospital database ina more dynamic, real-time manner. This is as opposed to a one time datadump from the hospital database.

Conceptually, one embodiment of the database situation is presented inFIG. 6 noted generally at 175. Hospital databases 176 may beinterconnected. An interface 178, such as any of those described aboveextracts the information from the hospital databases 176 and provides itto a proprietary central intermediate database 180 (this corresponds to70 and 152). Again, this may be an ORACLE database. Enterprise conduitsoftware 182, such as the aforementioned EXTENDED SYSTEMS' XTNDCONNECTSERVER, may be used to transport information from the central database180 to the docking stations 76 or the radio heads 154, from which it isprovided to the mobile terminals 50, 100.

Icons 118 are illustrated in tabular form in FIG. 7. Scroll icons orbuttons 200 act to move medical providers between different menus orallow different icons 118 to be displayed in icon section 116. Theseicons may be used in place of the need for buttons on the mobileterminal 50 or 100.

Other possible icons include thermometer icon 202 that shifts themedical provider to an information screen containing informationrelating to the patient's vital statistics. This may be a free form dataentry field to record daily events. Further, it is contemplated that theprevious day's text is reproduced automatically for the next day withsome indicia (such as an asterisk) that the text is reproduced. Thus,the medical provider does not have to re-enter duplicative data everyday. Of course if a change is entered, this new data is displayed whereappropriate.

Prescription icon 204 shifts the medical provider to an informationscreen containing information relating to the current medications thatthe patient is receiving. It may be linked to software that checks forharmful drug interactions or the like.

Other labs icon 206 shifts the medical provider to an information screencontaining information relating to lab tests that may have been run forthe patient. This may be presented as a pop up list that lists labresults that can then be viewed by selecting from the list. These labtests may not be the most common sorts of tests, but are used withsufficient regularity to be included. The text of the pop up list isspecifically made large enough so that the medical provider can selectfrom the list with their finger rather than having to use a stylus.

Hotlist icon 208 shifts the medical provider to a customizableinformation screen. Medical providers can indicate which lab tests theydesire to see most frequently. This may be related to their specialtyarea for example. Thus, when this button is tapped, the medical provideris taken to the tests that provide him with the most information. Forexample, a cardiologist may want to know the results for three certaintests, whereas an intestinal doctor may want to know the results of adifferent set of four tests. This icon allows the medical provider toprogram the mobile terminal 50 or 100 to show these desired testresults.

CBC icon 210 shifts the medical provider to an information screencontaining information relating to test results from a very common setof tests known as CBC.

Chem7 icon 212 shifts the medical provider to an information screencontaining information related to test results from a very common set oftests known as Chem7.

Bug icon 214 shifts the medical provider to an information screencontaining information related to microbiology cultures. Thus, resultsfrom cultures sent on the person are available. E.g., blood infectiongrew from E. Coli.

Allergies icon 216 shifts the medical provider to an information screencontaining information related to allergies for that particular patient.It may be linked to the information in the prescription screen to checkfor allergic reactions to proposed medication regimens.

Other data fields include HD—the hospital day, derived from the date ofadmission on the hospital record; PD—post operative day; DX—diagnosis;OR—operative procedure the patient underwent; and HX—history. It iscontemplated that the PD button will cause a calendar to pop up and themedical provider may indicate the day on which an operation occurred.The DX field will allow the entry of free form text so that the medicalprovider may indicate in their own words the patient's relevantdiagnoses. Likewise, the OR field will allow the entry of free form textso that the medical provider may indicate the nature of the surgery andany other relevant details. Similarly, the HX field allows the entry offree form text about the history of the patient.

Not all of this information needs to be stored in the hospital databasewith the unaltered medical records. Rather, it may be stored simply inthe central servers, 70, 152 and accessed by the medical providers asneeded or desired. This may comprise an economically important functionthat allows the database to be mined for critical data that is onlyaccessible to the end user.

The important thing about the icons is their ability to be seen easilyand manipulated easily. They are preferably large enough andergonomically designed so as to allow actuation without the need for astylus, but rather may be actuated with a thumb or other finger. Theyare preferably multicolored and intuitive so that medical providers mayat a glance know which icons will take them to what information. Theexact placement of the icons on a display is not critical, and may becustomized to the medical provider so that the icons most commonly usedappear on the main screens in a desired location.

Still other commands/icons may be incorporated into the displays 52,110. A PRINT command enables the medical provider to use infraredbeaming of the patient information to an IrDA compatible printer orother comparable device. A “Hotlist/Patient command allows the medicalprovider to indicate on the preferred first screen after selecting apatient's name from a list of patients. This button is exemplary of theergonomic innovation of the present invention in that it speeds workflow by allowing quicker access to the more relevant information thatthe medical providers need. This may be, for example, the hotlist testresults, or a general default patient information screen having HD, PD,and OR information. Other screens are also possible as needed ordesired.

A NOTE command takes the user to a totally freehand blank screen thatallows the medical provider to draw notes, pictures, or the like asneeded. This command in particular may be preserved in a particularposition on the display 52,110 in every screen, such as the lower righthand corner. Notes may be erased with an ERASER button on the scribblescreen. Further, the contents of this screen will be linked to thepatient file such that if a medical provider scribbles some notes abouta patient, then switches through multiple other screens and/or patientinformation, upon returning to the note button for the original patient,the notes are still available for the medical provider to view. This maybe done with memory in the mobile terminal 50, 100 or in the server thatstores the medical records.

A DETAILS command allows the medical provider to secure more detailsabout a particular lab or test result. In particular, it is expectedthat many lab or test results will be abbreviated with the most commonlydesired information presented first. Additional details will beavailable through the use of this command. Access to the additionaldetails will be achieved by touching the result set of interest on thescreen.

An ADD PATIENT command may be displayed as a “+” sign or the like, andallows the medical provider to enter a patient's medical record numberor other unique patient identifier manually, and at the nextsynchronization, the patient's complete medical record will be loadedinto the memory of the mobile terminal 50,100. In the situation wherethe mobile terminal is a mobile type device, this command will activatea call to the central server 152 and download the information. Thisfeature allows medical providers to acquire access to the medicalrecords of patients that were erroneously omitted from a synchronizationor added to the ward after a synchronization visit.

Other features are also possible. For example, as an alternate revenuegenerator, the service provider could sell advertising on a “Product ofthe Day” icon. This icon may likewise be ergonomically designed so thatit complements the rest of the icons and is used because it is easy andintuitive. This might be located in an unobtrusive portion of thedisplay 110 so as to avoid inadvertent triggering. Medical providers mayperuse this feature in down time, such as when waiting on an elevator,eating a meal, or the like. This may eliminate needless interruptions bysales representatives or the like. Further, in one embodiment of thepresent invention, when medical providers subscribe to the presentservice, they would identify their specialty areas and qualifications.This may be done to differentiate between medical students and attendingphysicians, nurses, and the like. With the identification of thespecialty areas, the advertising may be targeted specifically to thedesired audience. For example, cholesterol drugs could be advertised tocardio-thoracic surgeons while VIAGRA™ was advertised to a geriatricspecialist. In effect, this allows marksman marketing as opposed toshotgun marketing such as billboards, pamphlets, brochures, and thelike. It helps ensure that the information reaches exactly the desiredtarget audience.

As a security measure, if the mobile terminal 50, 100 is not used for anamount of time greater than a predetermined threshold, the medicalprovider may have to log in to the device. This may be done through anywell understood user name and password type log in activity. Further, ifthe mobile terminal 50, 100 is not used for an amount of time greaterthan a second predetermined threshold, the entire memory of the mobileterminal 50,100 may be purged of all medical records. This helps insurethat access to the confidential medical information is not given to anunauthorized user.

As yet another concern, the Health Insurance Portability Account Act(HIPAA) of 1997 has laid out several federal rules about electronic datatransfer as it relates to medical records. Individuals or companies whopractice the present invention need to be aware of the contemporaneousinterpretation of this statute to comply therewith.

Against this backdrop of hardware and software, the methodology ofpromoting the service is presented with reference to FIG. 8. Initially,the service provider establishes the database with the informationformatted in the appropriate manner (block 200). This process wasdescribed with reference to FIG. 1. The service provider may distributefor free mobile terminals 50, 100 (either personal digital assistants,mobile phones, or other appropriate device) to a select number ofmedical providers, for example, the first 1,000 medical providers (block202). At the same time, the service provider could require servicecontract commitments from the medical providers that have just receiveda new mobile terminal 50,100 (block 204). The service contract allowsaccess to the reformatted database and any other services that theservice provider provides and entails a monthly fee. Note further thatthe service provider may charge a monthly fee to the hospital or otherentity for maintenance of the database and inclusion of new medicalrecords. Thus, the service provider has residual revenue streams thathelp finance further expansions.

As part of the service contract process, the service provider maysolicit information from the medical provider relating to areas ofspecialty and nature of their authority (block 206). For example,physicians may have different access privileges than nurses or medicalstudents. Likewise, surgeons may need different information than afamily physician who has no surgery privileges at a hospital. Otherlevels of access may be defined as needed.

After the initial promotional give away, the service provider may sellbranded mobile terminals 50, 100 to medical providers with or withoutservice contracts (block 208). Obviously, the service is only providedto the medical providers who subscribe to the service, but some may justdesire a mobile terminal 50, 100. Discounts may be provided on thepurchase price of the mobile terminals 50, 100 for those medicalproviders who sign long term contracts.

As an added advertising ploy, the service provider may provide mobileterminals 50,100 and the service for free to medical students (block210) in teaching hospitals. This exposes the medical students to theconcept and utility of the service, fostering brand loyalty andoccupying part of the mental desktop of the students. Then, upongraduation, the mobile terminals 50, 100 are turned in to the serviceprovider, and the student embarks on his career. Already accustomed tothe service, the new physician may demand that the hospital at whichthey now work invest in the service as an invaluable tool. This hasworked extremely well in indoctrinating law students in the use ofWESTLAW and LEXIS, resulting in a steady stream of revenue for bothservices. Alternatively, instead of providing the service for free,reduced rates may be provided to medical students. As yet anotheralternative, teachers may be encouraged to use the service during roundswith their medical students so that copies of medical records areavailable to all of the students simultaneously without the need formultiple paper copies.

Once a few hospitals, especially teaching hospitals begin using theservice, the service provider may begin exploiting word of mouthadvertising (block 212). Medical providers are generally a gregariousgroup, attending conferences, continuing education classes, and tradeshows. Such arenas provide ample opportunity for those familiar with theservice to extol its virtues to those who have not yet subscribed. Thesenewly informed individuals may return to their establishments and demandthe service. Thus, the pool of subscribers expands.

Finally, the service provider may, after reaching a critical mass ofsubscribers, begin embarking on strategic expansions of service areasand services provided (block 214). For example, more hospitals may beconverted; small practice groups may be converted; and so on untilsubstantially all the medical providers are using mobile terminals50,100 to access their medical records in an ergonomic easy to accessmanner. Further, in addition to just medical records, the serviceprovider could adapt the service to include charge capture services,prescription writing services, content provision, and the like. Contentprovision may be Internet access along the lines of an AOL model,periodical article access, news releases about new drugs, and the likeas needed or desired. These additional services may be add-ons to thebasic service package, resulting in additional revenue for the serviceprovider, or packaged together as needed or desired.

Three such packages merit further exploration as being particularlycontemplated for use with the present invention. These add on featuresmay be sold independently of the provision of medical records service,but it is contemplated that these services will be designed with similarergonomic buttons that integrate easily into the medical record service.Medical providers using the medical record service will have at theirfingertips these additional services and use them as an outgrowth of thecore medical record service.

The first add-on service would be a hospital census service. Hospitalspresently have a large burden in estimating patient flow through thehospital for allocating bed spaces, alerting admitting physicians as tohow many beds are available for admissions and the like. This servicewould periodically inquire of the medical provider authorized to make adischarge of a patient when the medical provider expects to dischargethe patient. Thus, the medical provider may indicate on the day aftersurgery that the patient is expected to stay for one week, but on thethird day may indicate that the patient is healing better than expectedand will be discharged the following day. This alerts the hospital tothe opening of a bed space for planning purposes. The information may bestored in the same database as the medical records or separately asneeded or desired. The inquiry may be through a pop up screen as whenthe medical provider closes a particular medical record, as anadditional icon, or other technique as needed or desired.

The second add-on feature that is specifically contemplated is a featurethat allows charge capture services to be implemented in conjunctionwith the use of the medical record. Presently, hospitals have todetermine inferentially whether a service that justifies a charge hasbeen performed. This is due in large part to the hurried nature underwhich many of these services are performed and the fact that the medicalprovider performing the service may not remember at a later time toenter the appropriate information. Thus, the service provider mayinclude a charge capture icon or the like that inquires of the medicalprovider what services have been provided to a particular patient at atime relatively close to the provision of the services so as to increasethe likelihood that the medical provider remembers exactly what serviceshave been provided and thus may be billed. As an alternative to an icon,this inquiry may be in the form of a pop up window when the medicalprovider closes a particular record.

The third add-on feature comprises a reference interface. Selection ofan appropriate icon would take the medical provider to referencematerial relevant to the subject about which they are concerned at themoment. These reference materials may be textbooks, the PDR, periodicalsor the like. In general, periodicals may be a bit too dynamic for asynchronizing mobile terminal 50, but may be accessible by a wirelessmobile terminal 100. The reference icon may take the medical provider toa dedicated search engine that only searches medical references for thedesired information. Alternatively, actuating the reference icon mayforce the controller of the mobile terminal 50, 100 to evaluate the lastcommand given prior to actuating the reference icon and inferentiallydetermine what sort of resource is desired. For example, if a particularone of the Chem7 tests was being viewed in detail, and the medicalprovider then actuates the reference icon, the medical provider may thenbe provided information relevant to that test and potential diagnosis.The reference source may be provided in a HTML or WML format so that if,for example, the test states that results of X are indicative of acertain disease, the medical provider may immediately be linked toinformation about that disease. Other formats are also contemplated.

Exemplary methods of using the present invention by medical providersare presented in FIGS. 9 and 10 as flow charts. These are exemplary andnot intended to be limiting, but are provided to illustrate how thepresent invention may be used by a medical provider to make his lifeeasier. FIG. 9 assumes that the medical provider has a personal digitalassistant type mobile terminal 50. In particular, the medical provideris assumed to be a physician, although as noted above, the medicalprovider could in fact be a physician extender or the like such as a PA,RN, case manager, medical student or the like. The physician initiallysecures a mobile terminal 50 and a service contract (block 300). Thismay be the result of an advertising promotion, word of mouthadvertising, or other reason. At some later point, the physician hasbegun using the personal digital assistant as a calendar and the like.The physician wakes up (block 302) and as part of his morning ritual,checks his calendar on the mobile terminal 50 (block 304) to see theday's appointments. Note that this calendar software is conventional onmost personal digital assistants and is not necessarily incorporatedinto the software of the present invention. Both applications resideconcurrently in memory on the mobile terminal 50. This may be in themidst of breakfast, between shaving and showering, or whenever isconvenient.

The physician then goes to the hospital (block 306). One of the firstthings that the physician does is to dock his mobile terminal 50 at adocking station 76 to download all the needed medical records to themobile terminal 50 (block 308). Note that the physician may only getmedical records for his patients, the patients on the ward in which thephysician works, or some other subset of all available medical records.This preserves memory in the mobile terminal 50 if desired. Somephysicians may restrict access to their patients' medical records forsome reason. In such a case, these may not be provided to anotherdoctor. Of course, it is possible that every medical provider gets everymedical record if so desired on the part of the service provider.

Armed with the medical records in the mobile terminal 50, the physiciandoes his morning rounds. As part of these rounds, the physician accessesthe medical records from the bedside (block 310). This allows thephysician to observe the patient while reflecting on the information inthe medical records. To that end, the physician may use their thumb toscroll between different screens of information in the medical record(block 312). Appropriate use of the special icons 62 and the scrollicons 60 facilitates this information access. A stylus or other dataentry means may be used by the physician to enter new information intothe medical record if desired.

The physician completes his rounds and has lunch. During lunch, thephysician reads an ad for a new drug related to treating hemophilia(block 314). As one of the patients in an upcoming procedure is ahemophiliac, he makes a note to order some, or at least investigatefurther.

Before beginning his afternoon rounds, the physician docks his mobileterminal 50 again at a docking station 76 (block 316). This is donewhile conferring with a nurse as to the status of a particular patientabout whom the physician was concerned. This docking uploads anyinformation entered by the physician to the central server 70, whiledownloading any other information that has been entered since themorning docking.

After completion of the rounds, and a final docking session (not shownexplicitly), the physician checks the calendar for the next day'sappointments (block 3 18) and sets his alarm clock accordingly (block320).

The methodology of the mobile terminal 50 is not too dissimilar fromthat of the methodology of the mobile terminal 100. The primarydifference is the absence of the need to dock the mobile terminal.Reference is made to FIG. 10 for the methodology associated with usingthe mobile terminal 100. The initial part of the process is identical tothat described above, namely blocks 300-306. The physician begins hisrounds (block 350). Upon needing the medical record of a patient, thephysician places a phone call to the server 152 (block 352). Thephysician then accesses the desired medical record (block 354). Thisphone call may be encrypted as desired to protect the privacy of theindividual whose medical record is then transmitted to the mobileterminal 100 through the local, wireless telephone system. The physicianuses the ergonomic buttons on the mobile terminal 100 to scroll throughand select the desired screens of information (block 356).

If the physician enters new information into the medical record, themobile terminal 100 sends the update to the central server 152 (block358) by transmitting to a nearby radio head 154 and communicatingtherethrough with the central server 152. Upon completion of thephysician's rounds, the physician may terminate the phone call (block360). Again the physician may check ads during lunch (block 314). Theafternoon rounds proceed substantially as the morning rounds did, withthe physician placing calls to the server 152 as needed to accessadditional medical records (block 362). The physician's day endingroutine is likewise similar (blocks 318 and 320).

While the events in the flow charts of FIGS. 9 and 10 are illustratedlinearly, it should be readily apparent that the actual order of many ofthe events may take place as needed or desired. Life in general isnonlinear and disruptions in routine may certainly occur. Medicalproviders may dock more often than indicated if desired, or lessfrequently if desired. Further, updates may have to be entered throughother means rather than through the mobile terminals 50 and 100. Theflow charts are to illustrate exemplary embodiments.

The present invention may, of course, be carried out in other specificways than those herein set forth without departing from the scope andthe essential characteristics of the invention. The present embodimentsare therefore to be construed in all aspects as illustrative and notrestrictive and all changes coming within the meaning and equivalencyrange of the appended claims are intended to be embraced therein.

What is claimed is:
 1. A mobile device comprising: an electronicinterface configured to communicate with a server; a user interface; adisplay; and non-transitory computer-readable media having storedthereon computer-readable instructions for instructing the mobile deviceto perform actions comprising: receiving, via the electronic interface,medical records for electronic presentation on the display; andformatting the medical records including providing to a user ergonomicactuators electronically shown on the display within the medicalrecords, the electronic actuators being configured to receive user inputfor moving between different screens containing different classes ofmedical information regarding an associated patient; wherein eachergonomic actuator is large enough to allow actuation via a user'sfinger, at least one of the ergonomic actuators is configured to receiveuser input for generating a customizable information screen that permitsa medical provider to customize medical test results that areelectronically displayed on the display screen, activation of at leastone of the ergonomic actuators causes automatic search, retrieval anddisplay of medical reference information from a resource inferred andselected based on a type of patient test data associated with a prioruser command most recently received at the mobile device.
 2. The mobiledevice of claim 1, the computer-readable instructions further comprisinginstructions for extracting the medical records from a hospital databaseprior to formatting the medical records for presentation on the mobileterminal, wherein extracting the medical records includes determiningstructure of the hospital database.
 3. The mobile device of claim 1, thecomputer-readable instructions further comprising instructions forsending a request, via the electronic interface, to receive an updatefor one or more of the medical records.
 4. The mobile device of claim 1,the computer-readable instructions further comprising instructions forreceiving, via the electronic data interface, the update for the one ormore medical records.
 5. The mobile device of claim 1, wherein theergonomic actuator is configured for direct actuation by the user'sfinger without the use of a stylus.
 6. The mobile device of claim 1,wherein the electronic interface comprises a connection with a dockingstation.
 7. The mobile device of claim 1, wherein the electronicinterface comprises a wireless interface.
 8. A mobile terminalcomprising: an electronic interface configured to communicate with aserver; a user interface; a display; and non-transitorycomputer-readable media having stored thereon instructions forinstructing the mobile device to perform actions comprising: receivingformatted medical records information via the electronic interfaceincluding at least one of lab result information, vital signinformation, and prescription information for a patient; storing theformatted medical records in a computer memory of the mobile device;displaying on the display user-selectable ergonomic features for thepatient's medical information including at least one of the lab resultinformation, the vital sign information, and the prescriptioninformation, each one of the ergonomic features being large enough toallow actuation via one of the user's fingers; receiving user selectionof one the displayed ergonomic features via the user interface; andautomatically searching, retrieving and displaying medical referenceinformation for the user-selected ergonomic feature from a resourceinferred and selected based on a type of patient test data associatedwith a prior user command recently received at the mobile terminal. 9.The mobile terminal of claim 8, wherein, for receiving formatted medicalrecords information via the electronic data interface, the formattedmedical records are received through a docking station.
 10. The mobileterminal of claim 8, for receiving formatted medical records informationvia the electronic data interface, the formatted medical records arereceived wirelessly.
 11. The mobile terminal of claim 8, wherein theergonomic features are configured for direct actuation by the user'sfinger without the use of a stylus.
 12. The mobile terminal of claim 8,wherein the electronic interface comprises a connection with a dockingstation.
 13. The mobile device of claim 8, wherein the electronicinterface comprises a wireless interface.
 14. A mobile devicecomprising: an electronic interface configured to communicate with aserver; a user interface; a memory for storing medical informationregarding at least one patient; a display; and non-transitorycomputer-readable media having stored thereon computer-readableinstructions for instructing the mobile device to perform actionscomprising: receiving via the electronic interface a main databasecomprising medical information regarding at least one patient, the maindatabase comprising a census of a plurality of patients within themedical facility and an expected discharge time for each of theplurality of patients; electronically displaying on the display themedical information and pictorial ergonomic actuators that permitmovement between different screens containing different classes of themedical information, wherein each ergonomic actuator is large enough toallow actuation via a user's finger without the use of a stylus;receiving, via the user interface, updated information from the doctorat the mobile terminal; and sending, via the electronic interface, tothe server the updated information for updating a main database; whereinreceiving user activation of at least one of the ergonomic actuatorscauses automatic search, retrieval and display of medical referenceinformation from a resource inferred and selected based on a type ofpatient test data associated with a prior user command recently receivedat the mobile terminal.
 15. The mobile device of claim 14, wherein theelectronic interface comprises a connection with a docking station. 16.The mobile device of claim 14, wherein the electronic interfacecomprises a wireless interface.
 17. The mobile of claim 14, wherein thecomputer-readable instructions further comprise instructions for:receiving, via the user interface, the update for the one or moremedical records; and transmitting, via the electronic interface, theupdate of the one or more medical records to the server.
 18. The mobiledevice of claim 14, wherein the computer-readable instructions furthercomprise instructions for: receiving, via the user interface, updatedinformation from the doctor for changing the expected discharge time forone of the patients; and transmitting, via the electronic interface, theupdated information from the doctor for changing the expected dischargetime for the one of the patients to the server for updating theanticipated discharge time from the medical facility for the associatedpatient.
 19. The mobile device of claim 14, wherein the medicalinformation for each patient comprises treatment updates and a billlisting services indicated in the treatment updates.
 20. The mobiledevice of claim 14, wherein the medical information for each patientcomprises advertising targeted to a specialty area for the patient'streatment.